How to capture chronic care revenue with an IT infrastructure

When Curtis Story, MD, a solo primary care physician in Port Charlotte, Florida, first heard that Medicare would begin paying physicians for offering patients chronic care management (CCM), he was optimistic that the additional revenue would bolster his practice for work it was already doing. But more than a year later, he has yet to bill for CCM.

Story is not alone. A 2015 survey of 309 provider organizations by PYA and Enli Health Intelligence found that early adopters are struggling with physician engagement, patient education, efficient processes and regulatory compliance. 

To bill for CCM services, practices must offer 24/7 access to care management services, a platform for direct patient-practitioner communication and the ability to manage transitions between providers and settings.

Story couldn’t figure out how to make the program’s requirements fit with his practice’s workflow. For instance, he found that the requirement for tracking the time he, his medical assistant and care coordinator spend on tasks for these patients, and the time spent billing for the new code, would be inconvenient and time-consuming. His electronic health record (EHR) system doesn’t have features to help him with these tasks. “I am not sure it would be worth the effort,” he says.

“Having the IT capability in place to support CCM is absolutely a huge issue,” says Naomi Levinthal, MS, a senior consultant with The Advisory Board, a technology, research and consulting firm. She adds that very few of the firm’s clients are billing for CCM. The Centers for Medicare & Medicaid Services requires practices to use EHRs that meet its certification standards when billing for CCM.

To comply, physicians are finding they have to work with their EHR vendor or develop workarounds of their own, she says. “I imagine many providers will be going to their EHR vendor and saying this is something they want to do and asking for help,” she says. “It would behoove the industry to make this as easy as possible.”

Traditionally, physicians were told never to code based on time, but CCM is among a handful of relatively new codes that require tracking the amount of time spent on the activity, says Atlanta-based practice consultant Elizabeth Woodcock, MBA, FACMPE. She adds that practices had gotten used to not being paid for non-face-to-face work. “Now they can,” she says. 

Make a list

For practices considering whether it is worthwhile to try enrolling their patients, Woodcock has some “old-school” advice: create a list of 20 potential high-need patients and tape it by the phone. 

“Don’t bill yet; just mark how many minutes you spent with each patient. At the end of the month, add it up and see how many patients you spent 20 minutes on,” she says. Then try to determine if that time is financially worth tracking and billing for, and working on technology integration. 

Outside help

Another option is to outsource the CCM responsibility to one of the independent firms springing up to provide the required services. Michael Paul Gimness, MD, a solo family practitioner in Plant City, Florida, pays a company to help manage CCM, yet still sees significant revenue from his 147 enrolled patients.

Story and his staff members haven’t given up on CCM. “We still talk about it every week,” he says.